Clinical and spyrometric follow-up from 4 to 9 years after lobectomy for congenital lung malformations in children

Abstract

Background: Asymptomatic Congenital Lung Malformations (CLM) are often electively resected on the assumption that lobectomy has low impact on respiratory health and function. A recent meta-analysis showed that elective resection is safe and prevents the risk of symptoms development, which may result in a higher rate of postoperative complications.

Aim of the study: To assess respiratory symptoms and lung function at school age in children who underwent lobectomy for asymptomatic CLM.

Materials and Methods: We retrospectively reviewed performance, symptoms (open interview) and spirometric values of FEV1, FVC, FEV1/FVC and FEF75-25 with comparison to z-scores (Stanojevic S. et al., Am J Crit Care Med 2008;177(3):253-60) of 18 patients between 4-9 years of age.

Results: Between 2000-2009, 18 patients (9 female, 9 male) underwent elective lobectomy (8 upper left, 3 lower left, 6 lower right, 1 middle lobe) in our hospital, 13 patients within the first year of life and 5 after. The pathologic diagnoses were: 6 congenital lobar emphysema, 2 pulmonary sequestration and 10 Congenital Pulmonary Airway Malformation (CPAM).

At follow-up observation at 4-9 years of age, 14 patients were symptoms free and their effort tolerance was comparable to peers; 3 patients had effort dyspnea and reduced effort tolerance, 1 had occasional wheeze controlled with inhaled corticosteroids therapy.

Mean and median of FEV1, FVC and FEV1/FVC were within normal range if compared to z-scores, while FEF75-25 was lower (mean 1%, median 3.2%).

Conclusions: The majority of our 18 patients were symptoms free, 4 had mild symptoms and limitations. Lung function was essentially within predicted values.